Extremely premature infants born at 22 to 25 weeks of gestation have low rates of survival, and many of those infants who live have severe or moderate neurodevelopmental impairments. Thus, clinicians and families face the extremely difficult decision to either provide active, potentially lifesaving treatment at birth, or just provide comfort care. Furthermore, a wide, unexplained between-hospital variation in survival and impairment rates leaves it unclear whether treatment will be in the infant's interest. more